Technique

Curvilinear/large convex probe is ideal but phased array probe may be substituted

Linear probe for lung sliding though curvilinear or phased array probes can be substituted with depth decreased

Location

Sequence can vary depending on mechanism of injury

Include cardiac, RUQ, pelvic, LUQ views, and pulmonary views

Cardiac

Location

Subxiphoid

Landmarks

Visualize the heart and pericardium using the liver as an acoustic window

Scan anterior to posterior through the heart

RUQ

Location

Coronal view over the right flank

Landmarks

Visualize the interface between the liver and kidney

Scan anterior to posterior identifying Morison’s pouch and the superior and inferior pole of the kidney

Pelvic

Location

Sagittal view just superior to the pubic symphysis

Landmarks

Identify the bladder

Scan medial to lateral to identify fluid posterior and superior to the bladder

LUQ

Location

Coronal view over the left flank

Landmarks

Identify the space between the spleen and diaphragm and the spleen and the kidney

Scan through anterior to posterior of the splenodiaphragmatic space and superior and inferior pole of the kidney

Pulmonary

Location

Coronal view over the right and left diaphragm (curvilinear probe)

Sagittal view over the midclavicular line between the 2nd and 3rd intercostal space (linear probe)

Landmarks

Identify the interface between the diaphragm and lung on right and left (curvilinear probe)

Identify lung sliding between two ribs over the anterior thorax (linear probe)

Scan

Scan anterior to posterior over the diaphragm on right and left (curvilinear probe)

Hold probe in place between rib space observing for movement along the pleural line (linear probe)

Findings

Positive FAST will have one of the following:

Anechoic area within the pericardial space

Anechoic areas between the liver and kidney

Anechoic areas between the diaphragm and spleen

Anechoic areas between the spleen and kidney

Anechoic areas between superior and posterior to the posterior wall of the bladder

Positive EFAST will have one of the added pulmonary findings:

Anechoic area above the diaphragm between the diaphragm and lung

Absent lung sliding - lack of lung rockets seen under the pleural line

Images

Normal

Normal subxiphoid view

RUQ with no free fluid

Normal saggital bladder

Normal lung sliding

Normal lung sliding

Abnormal

Pericardial effusion

Positive FAST (RUQ)

Positive FAST (RUQ)

Free fluid superior to the bladder

Positive FAST (LUQ)

Absent lung sliding

Pearls and Pitfalls

Morison’s pouch

Scans must scan through the inferior poles of the kidneys as this can contain small quantities of fluid

Serial exam may be needed

Negative exam does not rule out intraabdominal injuries

Retroperitoneal hemorrhage no easily identified

Those with delayed presentation may have clotted and not completely anechoic fluid collections

Documentation

Normal Exam

A bedside EFAST ultrasound was conducted to assess for free fluid with clinical indication of trauma. Cardiac, RUQ, pelvic, LUQ, and pulmonary views were adequately obtained. There was no free fluid identified. There was no pneumothorax or hemothorax identified.

Abnormal Exam

A bedside EFAST ultrasound was conducted to assess for free fluid with clinical indication of trauma. Cardiac, RUQ, pelvic, LUQ, and pulmonary views were adequately obtained. There was free fluid identified in the RUQ suggesting intraabdominal hemorrhage. There was a pneumothorax on the left.